110 Bullet Wounds to the Neck

Ordog, Gary J.; Albin, David M.; Wasserberger, Jonathan; Schlater, Theodore L.; Balasubramaniam, Subramaniam

doi:10.1097/00005373-198503000-00014

Cited by 71 publications

(19 citation statements)

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“…The reported incidence of direct neurologic injury in penetrating cervical trauma ranges from <1%-7% [1,3,9,40]. Direct CSCI was noted in 3.06% of surviving patients in this study and found agreement with the prior reported incidence range.…”

Section: Discussionsupporting

confidence: 91%

“…Major vascular injury occurred in 11% of surviving patients which constituted a nearly 3.5-fold greater incidence than direct CSCI. Prior studies reported major vascular injury complicating over 25% of penetrating cervical trauma [1,[7][8][9]17]. The source of discrepancy between the incidence of major vascular injury in this study and other reported studies was not clear but may represent statistical variance.…”

Section: Discussioncontrasting

confidence: 61%

“…CSI can impede medical care of vascular and respiratory injuries in cases of penetrating cervical trauma [3,5,6] which raises concern given that penetrating cervical trauma causes major vascular injury in over 25% of patient with an incurred 50% mortality [1,[6][7][8][9]. Central neurologic injury frequently results from common and internal carotid artery (ICA) injuries which are the most commonly injured vessels [1].…”

Section: Introductionmentioning

confidence: 99%

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Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Turnock¹,

Carney²,

Fleischer³

et al. 2016

Trauma Emerg Care

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This study hypothesized that cervical spine immobilization (CSI) in penetrating cervical trauma is associated with increased central neurologic injury rather than prevention. Data abstraction proceeded from a previously constructed patient database formed via retrospective chart analysis of the trauma registries of two independent American College of Surgeons verified Level 1 Trauma centers. Neurologic injuries were categorized as peripheral or central. Central neurologic injuries were further subdivided into spinal cord and brain injuries. Patients were grouped according to the presence and type of neurologic injury, the presence and type of cervical spine fracture, death, and the presence or absence of respiratory and vascular injury. Vascular injury was further subdivided into major and minor categories. Groups were compared statistically. Significance was accepted for p<0.05. Cervical spine fracture (CSFx) was a significant risk factor for cervical spinal cord injury (CSCI) (p<0.00001; RR 20.56; 95% CI 8.44-26.47) but all patients with unstable CSFx presented with complete spinal neurologic devastation. Major vascular injury was associated with brain injury (p=0.01; RR 10.21; 95% CI 6.67-15.65) but was not associated with CSCI (p=0.99) or CSFx (p=0.67). Hypoperfusion was a strong independent risk cervical cord and brain injury (p<0.00001; RR 38.4; 95% CI 16.17-91.2). CSI was a significant risk factor for indirect central neurologic injury (p<0.001; RR 1.63; 95% CI 1.23-1.95). Brain injury was not associated with CSFx (p=0.35) or CSCI (p=0.08). No benefit of CSI in penetrating cervical trauma could be determined from this study. CSI entailed an absolute risk increase for central neurologic injury of 18.69% with a 5.3 number needed to harm (NNH).

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Turnock¹,

Carney²,

Fleischer³

et al. 2016

Trauma Emerg Care

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“…6) The primary concern in managing such injuries is control of bleeding 1,7,13,14) and airway management. 7,11) Serious injuries resulting from penetrating neck trauma may be clinically asymptomatic 10,13) or masked by coma and other life-threatening injuries. The leading cause of death in penetrating neck trauma is vascular injury.…”

Section: Discussionmentioning

confidence: 99%

Settled Nail Injury in the Corpus of the Seventh Cervical Vertebra -Case Report-

Gülşen

Sonmez

Aydemir

et al. 2007

Neurol. Med. Chir.(Tokyo)

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A 26-year-old construction worker presented with a nail settled in the C-7 corpus. He had no neurological or physical abnormalities. Preoperative evaluation of the vascular, neural, and aerodigestive structures with cervical radiography, computed tomography (CT), CT angiography, and contrast esophagography found no damage. The nail was completely exposed surgically and removed. The patient recovered with no deficits. Penetrating neck injury may be associated with significant morbidity and mortality due to vascular, neural, and aerodigestive tract injury. Patients in stable clinical condition should be evaluated by CT angiography, esophagography, and chest and cervical radiography.

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“…We therefore separated gunshots to the neck from other trauma mechanisms. Only few studies specifically focusing on gunshots to the neck have been reported [3][4][5][6]15]. In 1979, Stromberg [15] was the first to report a study on penetrating trauma to the neck limited to only bullets as an injuring agent.…”

Section: Discussionmentioning

confidence: 99%

Is Routine Angiography Necessary in Patients with a Gunshot Wound to the Neck? A Retrospective Analysis

Deurzen

Verleisdonk

2002

Eur J Trauma

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Aim: The aim of this study was to investigate the implication of clinical findings of vascular injury and routinely employing angiography in patients who sustained a gunshot to the neck. Patients and Methods: We retrospectively studied the demographics, bullet tract, clinical findings, diagnostic investigations, methods of treatment, outcome, and time in hospital of 70 patients who sustained a gunshot to the neck and who all underwent angiography. Results: In nine cases angiography revealed lesions to the common carotid artery (four patients), internal carotid artery (three patients), vertebral artery (one patient), and lingual artery (one patient). Physical examination had already indicated vascular damage in seven of these patients with findings such as expanding hematoma (four patients), absent carotid pulsations (two patients), bruit (one patient), and hypovolemic shock (one patient). Subsequently, these seven patients were treated operatively by performing elective neck exploration. Of these seven patients who underwent surgical repair, vascular damage was already suspected based on physical examination. The two patients with injury on angiography without clinical evidence did not deteriorate on conservative management. Conclusions: Careful clinical assessment proves to be a useful instrument in determining the necessity of surgical exploration. In our experience in 70 patients, the results of angiography did not alter the management of the patients who sustained a gunshot to the neck.Our results on conservative management with selective angiography indicate that morbidity and mortality of unnecessary neck explorations are avoided without increased risk.

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110 Bullet Wounds to the Neck

Cited by 71 publications

References 0 publications

Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Settled Nail Injury in the Corpus of the Seventh Cervical Vertebra -Case Report-

Is Routine Angiography Necessary in Patients with a Gunshot Wound to the Neck? A Retrospective Analysis

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